Infertility

The lack of ability to create offspring, which can result from a problem in either the female or the male reproductive system, or in some cases, from a combination of problems in both.

Female infertility

The most widespread cause of female infertility is failure to ovulate. Other causes are damaged, blocked, or absent fallopian tubes; disorders of the uterus, such as endometriosis and fibroids; problems with fertilisation; or problems with implantation in the uterus. Infertility also arises in the woman’s cervical mucus holds antibodies that immobile or kill her partner’s sperm. Hardly ever, a chromosomal abnormality, such as Turner’s syndrome, is the reason for a woman’s infertility.

Male infertility

The main cause of male infertility is lack of healthy sperm. In azoospermia, no sperm are made; in oligospermia only some sperm are produced. In certain cases sperm are produced by are short lived or malformed.

The underlying cause of these issues can be blockage of the spermatic tubes or damage to the spermatic ducts, often due to a sexually transmitted infection. Abnormal development of the testes due to a endocrine disorder or injury to the tests by orchitis can also create defective sperm. Various drugs, smoking, or toxins can lower the sperm count. Other factors are disorders affecting ejaculation. Unusually, male infertility is created by a chromosomal abnormality, such as Klinefelter’s syndrome, or a genetic disease, for example, cystic fibrosis.

Investigation

The initial investigation carried out for male infertility is semen analysis, which involves a sperm count. Investigations to uncover the cause of a woman’s infertility can include urine and blood tests to see if ovulation is occurring, X-ray examinations or ultrasound scanning are used to assess whether the fallopian tubes are blocked, and laproscopy to see if a condition, such as endometriosis, is present.

Treatment

There are a range of possible treatment for male infertility, depending on the cause. In azoospermia due to blockage of the spermatic ducts, it can be possible to extract sperm directly from the testes or epididymis. The sperm sample can then be used for intracutoplasmic sperm injection (ICSI) in conjunction with invitro fertilisation (IVF). In certain cases of male infertility created by hormone imbalance, drugs like clomifene or hormone therapy can be helpful. If no sperm at all are produced by the testis, the only other options are artificial insemination by a donor or adoption of children.

Failure of the woman to ovulate needs ovarian stimulation with a drug such as clomifen, administered either with or without a gonadotrophin hormone. Microsurgery can occasionally repair injury to the fallopian tubes. If surgery is not successful, IVF is an option. Uterine disorders or abnormalities, such as fibroids, can need treatment. In certain cases, as long as the woman has normal fallopian tubes, either gamete intrafallopian transfer (GIFT) or zygote intrafallopian transfer (ZIFT) can be undergone.